Dental care for a person living with dementia should preserve comfort, function, dignity and daily mouth care while adapting communication, consent and treatment burden to cognitive and functional change. Prevention and familiar routines become increasingly important as the ability to report symptoms or perform self-care declines.
Contents
Person-centred oral assessment
- Establish the person’s wishes, communication style, decision-making capacity and authorised support.
- Record medical conditions, medicines, swallowing risk, mobility, behaviour and previous dental experiences.
- Assess pain, infection, caries, periodontal disease, dry mouth, dentures, trauma and oral cleanliness.
- Look for non-verbal pain indicators such as changed eating, sleep, facial expression, behaviour or denture refusal.
- Identify who provides daily mouth care and whether they have equipment, training and a written plan.
- Agree realistic review arrangements before attendance becomes difficult.
Adapt the dental encounter
Use short concrete explanations, one instruction at a time, familiar carers when appropriate and a calm environment. Schedule at the person’s best time of day and reduce unnecessary waiting. Capacity is decision-specific and can fluctuate; do not assume incapacity solely from a dementia diagnosis. When the person cannot decide, follow applicable law and best-interest processes, using the least restrictive reasonable option.
Needs-based care table
| Challenge | Clinical risk | Adaptation |
|---|---|---|
| Reduced dexterity or sequencing | Ineffective plaque control | Powered brush, prompts or caregiver assistance |
| Polypharmacy and dry mouth | Rapid caries and discomfort | Medication review, fluoride strategy and salivary support |
| Difficulty expressing pain | Late presentation | Use behavioural changes and regular oral checks |
| Unstable or poorly labelled dentures | Ulceration, loss or aspiration concern | Review fit, identification and wear routine |
| Increasing treatment intolerance | High burden of complex care | Prioritise prevention, comfort and durable simple plans |
Plan ahead and review goals
Early in the condition, stabilise active disease and discuss future preferences. Use high-value prevention, risk-based fluoride, diet support and caregiver training. Treatment choices should consider prognosis, comfort, function, ability to maintain the result and the burden of multiple visits. Acute swelling, trauma, uncontrolled pain, bleeding or suspected malignancy still requires timely assessment.
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